MEDICARE: DR. WILLIAM JOHN SHEA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	27558	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B27558-01	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1265659908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JOHN SHEA D.D.S.

Provider Business Mailing Address
First Line	:	450 SUTTER ST RM 2240
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4201
Country	:	US
Telephone Number	:	415-391-2929
Fax Number	:	415-216-0840

Provider Business Practice Location Address
First Line	:	450 SUTTER ST RM 2240
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4201
Country	:	US
Telephone Number	:	415-391-2929
Fax Number	:	415-216-0840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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